Donna M. D'Alessandro

Policy statement - Using personal health records to improve the quality of health care for children

A personal health record (PHR) is a repository of information from multiple contributors (eg, patient, family, guardians, physicians, and other health care professionals) regarding the health of an individual. The development of electronic PHRs presents new opportunities and challenges to the practice of pediatrics. This policy statement provides recommendations for actions that pediatricians can take to support the development and use of PHRs for children. Pediatric health care professionals must become actively involved in developing and adopting PHRs and PHR systems. The American Academy of Pediatrics supports development of: educational programs for families and clinicians on effective and efficient use of PHRs; incentives to facilitate PHR use and maintenance; and child- and adolescent-friendly standards for PHR content, portability, security, and privacy. Properly designed PHR systems for pediatric care can empower patients. PHRs can improve access to health information, improve coordination of preventive health and health maintenance activities, and support emergency and disaster management activities. PHRs provide support for the medical home for all children, including those with special health care needs and those in foster care. PHRs can also provide information to serve as the basis for pediatric quality improvement efforts. For PHRs to be adopted sufficiently to realize these benefits, we must determine how best to support their development and adoption. Privacy and security issues, especially with regard to children and adolescents, must be addressed.

Policy statement - Health information technology and the medical home

The American Academy of Pediatrics (AAP) supports development and universal implementation of a comprehensive electronic infrastructure to support pediatric information functions of the medical home. These functions include (1) timely and continuous management and tracking of health data and services over a patients lifetime for all providers, patients, families, and guardians, (2) comprehensive organization and secure transfer of health data during patient-care transitions between providers, institutions, and practices, (3) establishment and maintenance of central coordination of a patients health information among multiple repositories (including personal health records and information exchanges), (4) translation of evidence into actionable clinical decision support, and (5) reuse of archived clinical data for continuous quality improvement. The AAP supports universal, secure, and vendor-neutral portability of health information for all patients contained within the medical home across all care settings (ambulatory practices, inpatient settings, emergency departments, pharmacies, consultants, support service providers, and therapists) for multiple purposes including direct care, personal health records, public health, and registries. The AAP also supports financial incentives that promote the development of information tools that meet the needs of pediatric workflows and that appropriately recognize the added value of medical homes to pediatric care.

How Mentoring Relationships Evolve: A Longitudinal Study of Academic Pediatricians in a Physician Educator Faculty Development Program

Introduction: Mentoring is increasingly recognized as central to career development. Less attention has been paid, however, to how mentoring relationships evolve over time. To provide a more complete picture of these complex relationships, the authors explored mentoring from a mentees perspective within the context of a three‐year faculty development program in which the mentor provided specific expertise to assist the mentee in completing a scholarly educational project. Methods: Using an evolving focus group design, the authors interviewed mentee groups in 2007‐2009 inclusive. Transcripts were coded inductively; codes were revised as data patterns became more apparent. Preliminary assertions about the answers to guiding questions were made; the trustworthiness of the assertions was assessed via member check. Results: Mentees offered a variety of reasons for choosing their project mentor, including proximity, familiarity, and mentor expertise. There was a dyadic relationship with the project mentor in year 1, a broader collaboration with multiple senior mentors in year 2, and mentoring among program peers in year 3. Mentees benefitted from mentors supportive behaviors and, to a lesser extent, mentors challenging behaviors. Conclusion: Mentoring relationships, in the context of this faculty development program, tended not to be an exclusive dyadic connection but rather a constellation of relationships that evolved over time and included peer mentoring. The complex reality of these relationships challenges the application of traditional mentoring models and suggests unique considerations in developing mentoring programs designed to meet the needs of faculty in academic medicine.

An Analysis of Patient Care Questions Asked by Pediatricians at an Academic Medical Center

BACKGROUNDnGeneral pediatricians information needs are not presently well characterized in the literature.nnnOBJECTIVEnTo characterize the patient care information needs of academic medical center pediatricians by collecting and classifying questions generated in clinical settings, allowing pediatric educators and authors to more effectively meet the needs of pediatricians.nnnMETHODSnA semistructured telephone survey of pediatric residents and faculty at a midwestern US academic medical center over two 6-month periods. The main outcome measures were number of questions asked, age ranges, pediatric subspecialties, and generic question types.nnnRESULTSnA total of 607 pediatrician questions were collected. The infant age range generated the most questions (34.1%), and other age groups were almost equally distributed. The most common pediatric specialties were pharmacology (34.1%), infectious diseases (9.1%), neurology/neurosurgery (5.1%), allergy/pulmonary (4.6%), and neonatology (4.6%). The most common generic questions asked were What is the dosage of drug X? (18.0%), What is the treatment for condition X? (15.2%), and What is condition X? (13.5%). There were qualitative differences between resident and faculty groups.nnnCONCLUSIONSnThe information needs of academic medical center pediatricians can be assessed and potentially serve as a foundation for the development of common and digital educational information resources. Resident and faculty groups showed some qualitative differences. Pediatricians need drug-dosing information; clear condition definitions, including manifestation and clinical course descriptions; and physical finding and laboratory testing information. Educators and authors should highlight information concerning pharmacology and infectious diseases when developing educational and information resources.

Pediatric Jeopardy May Increase Residents' Medical Reading

OBJECTIVEnTo describe the implementation of a monthly pediatric jeopardy educational intervention (pediatric jeopardy) designed to increase resident reading.nnnMETHODSnPediatric jeopardy, based on the game show JEOPARDY!, was implemented in a pediatric residency training program in September 1997. The questions were derived from the current issues of Pediatrics in Review, Pediatrics, and Pediatrics Review and Education Program. Three residents from each training level competed in teams. Residents reading habits were briefly surveyed in May 1998 using a 23-item questionnaire.nnnRESULTSnPediatric jeopardy was implemented and has been continued because both residents and faculty members believed it is a valuable part of the overall residency training program. Some format changes have occurred since the initial implementation of the program. Residents are seen with journals throughout the month, and they speak positively about this conference. The questionnaire response rate was 89.2%. Residents self-reported reading an average of 350 minutes per month (5.8 hours) in May 1998. Residents reported that they felt that this program increased their knowledge, motivated them to read, and should be used in other residency training programs.nnnCONCLUSIONnImplementation of pediatric jeopardy may increase the amount of overall medical reading reported by the pediatric residents. Pediatric residents reported reading an average of 350 minutes per month. Residents felt this educational intervention was of significant educational value to them personally and should be used in other residency training programs.

Improving Usage of Pediatric Information on the Internet: The Virtual Children's Hospital

Objective. Digital health sciences libraries (DHSLs) bring order to the chaos of the Internet by making authoritative medical information easily and conveniently available to patrons. The goal of this project was to perform a baseline usage analysis of the pediatric-related information in a general DHSL and to determine whether reorganization of the pediatric-related information into its own pediatric DHSL could increase the usage of the pediatric-related information. Methods. From March through August 1997, a baseline analysis of a general DHSL (Virtual Hospital) was conducted using computer server log file analysis programs. The quantity of pediatric-related information in the general DHSL and its baseline usage were determined. In September 1997, the pediatric-related information was reorganized into its own pediatric DHSL (Virtual Childrens Hospital), and server log file analyses were conducted of the pediatric DHSL from September 1997 to August 1998. Statistical analysis was performed by time series autoregression. Results. During the baseline, the general DHSL and the pediatric-related information received a monthly average of 2u2009320u2009782 and 141u2009444 qualified hits, respectively. After the intervention, the general DHSL and the pediatric DHSL received a monthly average of 2u2009765u2009454 and 256u2009998 qualified hits, respectively. This is an increase of 19.2% for the general DHSL and 81.7% for the pediatric DHSL. These changes were statistically significant at theP > .0001 level. The most requested pediatric-related content in the pediatric DHSL did not change substantively from preintervention to postintervention. Discussion. On the Internet, as in real life, childrens services must have their own distinct identity and must be differentiated from adult services. Therefore, pediatric-related information will receive increased usage if it is part of a pediatric DHSL rather than part of a general DHSL. Others can use this process and the lessons learned to develop and enhance their own pediatric-related information on the Internet. Internet, pediatrics, digital health sciences libraries, digital library, medical library.

Electronic prescribing systems in pediatrics

The use of electronic prescribing applications in pediatric practice, as recommended by the federal government and other national health care improvement organizations, should be encouraged. Legislation and policies that foster adoption of electronic prescribing systems by pediatricians should recognize both specific pediatric requirements and general economic incentives required to speed the adoption of these systems. Continued research into improving the effectiveness of these systems, recognizing the unique challenges of providing care to the pediatric population, should be promoted.

Formative evaluation of a pediatric digital library's educational content and comparison to national curricular standards

Background: U.S. medical education has undergone numerous regulatory changes; to maintain educational consistency and quality, these changes must be met with innovative educational methods. Aim: A formative evaluation of a pediatric digital library (PDL) documenting its content and comparing it to 3 national medical education curricula was performed. Methods: The PDLs weekly cases are written using templates based on specific educational constructs. Cases (N = 150) were evaluated in November 2007. Data was tabulated by age group, specialty, symptom/presentation and disease/problem. Curriculum maps were developed from 3 national curricula and topics were mapped to one or more equivalent PDL topics. Data was tabulated for total national curriculum topics, mapped PDL topics and weekly cases. Results: The cases covered 100% of all pediatric age groups (N = 9) and specialties (N = 42). They covered 85% of the symptoms/problems (N = 127) and 37.2% of the diseases/problems (N = 707). Although the PDL was not explicitly designed to meet these national curricula standards, >80% of the topics in these curricula were covered. Conclusions: The PDL broadly covered national curricular standards and represents an unstructured pediatric curriculum. It offers a complementary and alternative educational method of medical education for educators and learners at all stages of professional development.